The word endometriosis comes from the word endometrium — which refers to the tissue that lines the inside of the uterus (womb).
Endometriosis occurs when tissue like that which lines the inside of uterus, grows outside the uterus in places that it is not supposed to grow – usually on the surfaces of organs in the pelvic and abdominal cavity.
The two most common symptoms of endometriosis are:
The most common types of pain experienced by women who have endometriosis are:
severe menstrual cramps
chronic pelvic pain
Pain can be so intense that it can affect a woman’s quality of life possibly impairingsocial and professional functioning during what would otherwise be a very productive period in her life.
More about the pain
The severity of the pain does not always correlate with the extent of the disease — and endometriosis may also be found in women who experience few or no symptoms.
One of the most common symptoms of endometriosis is pelvic pain.
Pelvic pain associated with endometriosis usually occurs more or less the same time as menstruation (known as cyclical pain) although the pain may become continuous as the disease worsens.’
The “cluster” of symptoms that should raise the suspicion that endometriosis may exist are:
Heavy menstrual periods
Other painful symptoms such as low back pain, and bowel and bladder symptoms can also be present.
If endometriosis is found on the bladder or rectum it may be also be difficult to pass urine or have a stool.
Infertility and Endometriosis
Some women may only find out they have endometriosis when they seek medical help after struggling to fall pregnant. Sometimes, infertility may be the only symptom although not all women with endometriosis will be infertile.
Endometriosis can affect women who have had children and can occur in teenagers. It can also affect women who are postmenopausal.
Where does Endometriosis grow?
Endometriosis is mainly found in the female pelvis organs, including the uterus, ovaries, vagina, fallopian tubes, ligaments, bowel, bladder and ureters.
Endometriosis can also be found elsewhere in the body, including the brain and lungs!’
Endometriotic lesions i.e. stray pieces of endometrium can be found on organs in the pelvic region including the ovaries, bladder and bowel.
What does Endometriosis look like?
Early endometriosis implants look like small, flat patches or vesicles sprinkled on the pelvic surface. The flecks can be clear, white, yellowish/brown, pinkish, red, black or blue.
The stage or degree of endometrial involvement is based on a point system. The doctor will inspect the pelvis via an operation referred to as a laparoscopy and note the number, size and location of endometrial lesions, plagues and adhesions – and then assign points. Points are then calculated to indicate the stage of the disease.
Endometriosis is classified into one of four stages, I-minimal, II-mild, Ill-moderate, and IV-severe.
What causes Endometriosis?
We do not know the exact cause of endometriosis.’
There are a number of theories that may explain how endometriosis may occur. The main theory involves retrograde menstruation, but others include genetic, hormonal, immunologic and environmental factors.
Retrograde Menstruation: Endometriosis may result from so called “retrograde menstrual flow”, in which some of the tissue that a woman sheds during her period flows into her pelvis and attaches to surfaces in the pelvis — instead of draining out of the body through the vagina. While about 90% of women have some retrograde menstrual flow, not all of these women have endometriosis.
Genetic Factors: There appears to be a familial tendency of endometriosis which suggests that this disease could be inherited, or it could result from genetic errors, which makes some women more likely than others to develop the condition.
How do I know if I have Endometriosis?
Endometriosis is often difficult to diagnose because the symptoms mimic those of other pelvic conditions.
Other painful pelvic conditions include:
irritable bowel syndrome
pelvic inflammatory disease
It can take more than 8 years for a diagnosis to finally be made!’
You or your doctor should suspect endometriosis if you have /may be having:
severe menstrual cramps
pain during intercourse
chronic pelvic pain
family history of endometriosis
Who can get Endometriosis?
Although endometriosis is seen mainly in women who are in their childbearing years, it can affect adolescents and can sometimes persist after menopause. Endometriosis can even occur in women who have undergone hysterectomy.
Other risk factors include early onset of menses (periods), heavy menstrual flow and late menopause, short menstrual cycles and childlessness.
Can young girls also get Endometriosis?
Yes! Although in the past it was assumed that endometriosis presented only after many years of menstruation, studies have found that endometriosis can occur even before the onset of menstruation in young girls.
Why does Endometriosis cause pain?
During a normal cycle, if a woman is not pregnant, the tissue that lines the womb builds up on the inside of her womb, breaks down into blood and tissue, and is shed as her period. This cycle of growth and shedding happens every month – usually every 28 days – and is due to the influence of her hormones.
Keep in mind that in a woman that has endometriosis, the same type of tissue that is found lining the womb has for some reason, spread to areas outside the womb – in the pelvic area.
The severity and course of endometriosis is highly unpredictable. Some women may have a few endometriosis implants on the surface of the pelvis, the peritoneum, or pelvic organs, or it may invade the periotoneum and grow as nodules. Endometriosis may grow on the surface of the ovary as implants or invade inside the ovary and develop a blood filled cyst.
Endometriosis may irritate surrounding tissue and produce internal scar tissue called adhesions. These adhesions can bind the pelvic organs together, cover them entirely, or involve nearby intestines. Endometriosis may also grow into the walls of the intestine and into the tissue between the vagina and the rectum.
During sexual intercourse deep penetration can produce pain in an ovary bound by scar tissue to the top of the vagina. Pain also may be caused by bumping against a tender nodule of endometriosis behind the uterus or on ligaments which are connected to the cervix.
A laparoscopy is performed to confirm that you have endometriosis. Simultaneously the doctor may decide to remove your endometriosis during the laparoscopy:
Laparoscopy is usually performed under general anaesthetic. After the patient is under, a needle is inserted through the navel and the abdomen is filled with gas. The gas pushes the abdominal wall away from the internal organs so that the laparoscope (which is a small camera) can be placed safely into the abdomen.
The laparoscope is inserted through a small cut in the navel. While looking through the laparoscope, the doctor can see the reproductive organs including the uterus (womb), fallopian tubes, and ovaries.
Living with Endometriosis
Many women with endometriosis experience debilitating pain that can interfere with their daily life and have an impact on work and personal relationships. Lack of awareness of endometriosis is common.
It is also a common misperception that pain and heavy menstrual bleeding is “normal” and just something women have to “put up with”. Nothing could be further from the truth!
If you are experiencing any of the symptoms associated with endometriosis it is important that you seek medical help. You may be putting up with unnecessary painful symptoms that you have been told by friends and family are “normal”.
Is there a cure for Endometriosis?
No! currently there is no cure for endometriosis but there are a variety of treatments that doctors can prescribe.
Very recently a new medication has been launched onto the Malaysian market. This medication contains a progesterone, dienogest, and has been proven in clinical trials to slow the progression of the disease and effectively manage the pain associated with endometriosis.
What treatment options exists for Endometriosis?
There is no single treatment that works in all women. But there are medications that can reduce your pain and/or endometriotic lesions, preserve your fertility, and improve your quality of life.
The following sets out a summary of the various options and only provide an overview of what type of treatments are available. It is by no means exhaustive.
A) Medical Treatment Options
Non-steroidal anti-inflammatory drugs:
diclofenac, ibuprofen, naproxen, are advocated as first line therapy to relieve mild symptoms of pain.
Androgenic drug: These are medications that are similar to male hormones and are highly effective for endometriosis pain. Common side effects may include water retention, acne, irregular vaginal bleeding, muscle cramps, and temporarily reduced breast size. Uncommon, but irreversible side effects include deepening of the voice and growth of facial or body hair.
Combined Oral Contraceptives: (COC) Often reduce menstrual cramping and pelvic pain that may be associated with endometriosis.
But they cannot slow down the progression of the disease: Moreover, they are not approved for the treatment of endometriosis and their use is largely unsupported by solid clinical trial evidence.
Gonadotropin – releasing hormone (GnRH) Agonists: They work by causing estrogen levels to fall to menopausal levels, and menstruation does not occur. Therefore these drugs also induce a state of menopause. While they are highly effective in the treatment of endometriosis they can only be prescribed for a few months at a time due to their side effects – which include menopausal symptoms: hot flashes, vaginal dryness, and loss of calcium from the bones and thus an increased risk of developing osteoporosis.- In addition, the duration of symptom relief following treatment cessation is typically short, decreasing the cost-effective of GnRH agonists as compared to other approaches.
Progesterones: These medications act on the endometrium to reduce the growth of uterine lining, and reduce endometriosis-associated pelvic pain. Progesterones may be prescribed as pills, injections, or intrauterine contraceptive devices (IUDs).” However, a number of products in this class are associated weight gain at the doses that are required for efficacy.
B) Surgical Treatment Options
Laparoscopy: This is a procedure done under anaesthesia and is often used to diagnose endometriosis – as well as to treat recurrent endometriosis.
Keep in mind that while doctors can make a diagnosis based on the symptoms described to them and by taking a family history, endometriosis cannot be ruled out unless a laparoscopy is done.
Hysterectomy: This is a surgical procedure done to remove the whole uterus (womb). If the ovaries are also removed, the production of estrogen is effectively “switched off”. This treatment can be considered if you do not plan to have any more children and it will provide pain relief in many women.
This approach is often referred to as “definitive” therapy, however endometriosis may recur in up to 10% of women who have undergone hysterectomy.
Recently a medical advance has been made and now there is a specific medication for the treatment of endometriosis, Visanne’ – and it is available in Malaysia.
Visanne, in the form of a daily tablet, has a potent effect on the endometrium, stopping the growth of the endometrium lining as well as having anti-inflammatory actions.” It does not decrease bone mass and does not produce menopausal symptoms.
Studies for the treatment of endometriosis demonstrated that a significant decrease in pelvic pain and progressive decrease in bleeding was shown with Visanne. Longterm use showed a favourable efficacy and safety profile, with pain and irregular bleeding decreasing progressively during continued treatment.
If you have any of the symptoms mentioned above, please do not hesitate to contact Dr. Gan for an appointment.